Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 125.077713 | IL |
NPI | 1003494501 |
---|---|
Provider Name | Kelsey Rose Kennedy |
First Address | Oak Lawn, IL 60453-2600 |
Second Address | Oak Lawn, IL 60453-2600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2021 |
Last Update Date | 22/06/2021 |